Incisal embrasures are one of the most important factors that determine the aesthetics of a smile. They’re formed by the edges and the separations between the teeth and the dark background of the mouth. Their dimension and their volume increase as the dentition progresses distally from the midline. These embrasures tend to be reduced with age due to abrasion.
This patient presented to our clinic to enhance her smile. She complained of large incisal embrasures giving her the illusion of having diastemas and small teeth.
The clinical examination revealed:
– large incisal embrasures
– rounded teeth
– small and short laterals
– reduced incisal edges on the central and the lateral incisors
– surface irregularities
It is mandatory to always check the lateral movements in order to locate the safe zones eligible to receive the composite restoration without inducing occlusal interference that may lead to chipping of the restorations.
No preparation of the teeth was needed because the aim was to add, rather than reduce in volume. The fullenamel surface was ideal to optimize the restorations’ longevity. A rubber dam was placed.
Etching of the teeth was carried out with 37% phosphoric acid (Scotchbond, 3M/ESPE, St. Paul, MN, USA), following the total-etch protocol.
Afterwards, the adhesive single bond 2 (3M/ESPE, St. Paul, MN, USA) was applied in two consecutive layers, using a microbrush. A 5-second air blowing was performed after each layer to evaporate the solvent followed by light curing for 20 seconds using the Curing Pen by Eighteeth.
Two composite shades from CompoSite System by White Dental Beauty were used:
– Si 2, equivalent to A2, is the dentin shade used.
– Si E (Si Enamel), is used to give translucency and good opalescence properties to the restorations.
After completing the incised contour of all the teeth, we were ready to complete the shape.
The same procedure was repeated for all the proximal walls. Notice the new shape and length of the teeth.
Proximal mesial wall on the left canine.
After all teeth were completely contoured, we were ready for final layering.
After drawing the transitional lines and the secondary anatomy with a pencil, excess composite was removed using a tapered round-tipped bur with an extra fine grit.
By rubbing an articulating paper on the buccal side, we are able to mimic the surface texture on all the teeth.
The coarse red grit from Sof-Lex (3M/ESPE, St. Paul, MN, USA) was used to define proximal contour of the teeth. These discs should be used with caution in order to avoid removing the contact point or the transitional lines.
Direct composite restorations can be an ideal conservative treatment to enhance shape and incisal embrasures of the teeth. The key criteria to succeed these cases are to memorize dental morphology and to master the different layers of composite (enamel, dentine, transparent…) in order to have an excellent and natural blend between the restorations and the teeth.
1. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. The European journal of esthetic dentistry 2010;5:102-124.
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012
3. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
5. Dietschi D, Shahidi C, Krejci I. Clinical performance of direct anterior composite restorations: a systematic literature review and critical appraisal. The International Journal of Esthetic Dentistry 2019;14:252–270.
6. Foulger TE, Tredwin CJ, Gill DS, Moles DR. The influence of varying maxillary incisal edge embrasure space and interproximal contact area dimensions on perceived smile aesthetics. Br Dent J 209, 126–127 (2010).